Appendectomy - series

Normal anatomy

The appendix is a small, finger-shaped pouch of intestinal tissue arising from the cecum near its junction with the small intestine.

Indications

If the appendix becomes infected it must be surgically removed before it ruptures and spreads infection to the entire abdominal space. Symptoms of acute appendicitis include pain in the lower right side of the abdomen, fever, reduced appetite, nausea or vomiting.

Before surgery, the doctor will perform a physical exam. The physician will check the abdomen for tenderness and tightness and check the rectum for tenderness and an enlarged appendix. In women, a pelvic exam is also performed to exclude pain caused by the ovaries or uterus. Additionally, blood tests and X-rays may also be performed.

There is no test to confirm appendicitis and the symptoms may be caused by other illnesses. The doctor must diagnose from the information you report and what he sees. During appendectomy surgery, even if the surgeon finds that the appendix is not infected (which can happen up to 25% of the time), he will thoroughly check the other abdominal organs and remove the appendix anyway.

Incision

Depending upon the circumstances of the individual patient, an appendectomy can be performed in one of two ways, through an open incision or with a laparoscope.

In the open technique, an incision is made in the lower right side of the abdomen, through the skin, muscle wall, and peritoneum. The appendix is located and then carefully freed from the surrounding structures and removed.

In the laparoscopic technique, several small incisions are made in the abdomen. In one incision a laparoscope is inserted. The laparoscope has a tiny lens to which a TV camera is attached. The appendectomy is performed by the surgeon while looking at the TV monitor. Small instruments are inserted in the other incisions and used to to remove the appendix.

Procedure

If a pocket of infection has formed, or the appendix has ruptured, the abdomen will be thoroughly washed out during surgery. The surgeon may then leave the skin open and allow it to heal together on its own, to allow the infection to drain, or less frequently, put in a small drainage tube.

Aftercare

Recovery from a simple appendectomy is usually complete and rapid. Most patients can go home the day after the operation, and resume normal diet and activities within one to two weeks. If the appendix has developed an abscess or has ruptured, the recovery may be slower and more complicated, requiring use of medications to treat the infection (antibiotics).

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